Universität zu Köln

Reith, Sebastian, Milzi, Andrea ORCID: 0000-0001-7580-8029, Lemma, Enrico Domenico ORCID: 0000-0002-5436-9175, Dettori, Rosalia, Burgmaier, Kathrin, Marx, Nikolaus and Burgmaier, Mathias (2019). Intrinsic calcification angle: a novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: an optical coherence tomography study. Cardiovasc. Diabetol., 18 (1). LONDON: BMC. ISSN 1475-2840

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Abstract

Background Coronary calcification is associated with high risk for cardiovascular events. However, its impact on plaque vulnerability is incompletely understood. In the present study we defined the intrinsic calcification angle (ICA) as the angle externally projected by a vascular calcification and analyzed its role as novel feature of coronary plaque vulnerability in patients with type 2 diabetes. Methods Optical coherence tomography was used to determine ICA in 219 calcifications from 56 patients with stable coronary artery disease (CAD) and 143 calcifications from 36 patients with acute coronary syndrome (ACS). We then used finite elements analysis to gain mechanistic insight into the effects of ICA. Results Minimal (139.8 +/- 32.8 degrees vs. 165.6 +/- 21.6 degrees, p < 0.001) and mean ICA (164.1 +/- 14.3 degrees vs. 176.0 +/- 8.4 degrees, p < 0.001) were lower in ACS vs. stable CAD patients. Mean ICA predicted ACS with very good diagnostic efficiency (AUC = 0.840, 95% CI 0.797-0.882, p < 0.001, optimal cut-off 175.9 degrees); younger age (OR 0.95 per year, 95% CI 0.92-0.98, p = 0.002), male sex (OR 2.18, 95% CI 1.41-3.38, p < 0.001), lower HDL-cholesterol (OR 0.82 per 10 mg/dl, 95% CI 0.68-0.98, p = 0.029) and ACS (OR 14.71, 95% CI 8.47-25.64, p < 0.001) were determinants of ICA < 175.9 degrees. A lower ICA predicted ACS (OR for 10 degrees-variation 0.25, 95% CI 0.13-0.52, p < 0.001) independently from fibrous cap thickness, presence of macrophages or extension of lipid core. In finite elements analysis we confirmed that lower ICA causes increased stress on a lesion's fibrous cap; this effect was potentiated in more superficial calcifications and adds to the destabilizing role of smaller calcifications. Conclusion Our clinical and mechanistic data for the first time identify ICA as a novel feature of coronary plaque vulnerability.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Reith, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Milzi, Andrea UNSPECIFIED orcid.org/0000-0001-7580-8029 UNSPECIFIED Lemma, Enrico Domenico UNSPECIFIED orcid.org/0000-0002-5436-9175 UNSPECIFIED Dettori, Rosalia UNSPECIFIED UNSPECIFIED UNSPECIFIED Burgmaier, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Marx, Nikolaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Burgmaier, Mathias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-133724
DOI:	10.1186/s12933-019-0926-x
Journal or Publication Title:	Cardiovasc. Diabetol.
Volume:	18
Number:	1
Date:	2019
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1475-2840
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE MYOCARDIAL-INFARCTION; SPOTTY CALCIFICATION; ARTERY-DISEASE; MICROCALCIFICATIONS; RUPTURE; ATHEROSCLEROSIS; HYPOTHESIS; DEPOSITS; LESIONS; STRESS Multiple languages Cardiac & Cardiovascular Systems; Endocrinology & Metabolism Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13372